Lower Cholesterol Naturally

Lower Cholesterol Book

Since Scott Davis released the Beat Cholesterol In 30 Days program, many people used it to learn how to manage their hypercholesterolemia quickly and naturally. Due to his personal fight with the disease and the desire to completely avoid prescription meds, he discovered the most effective techniques to overcome this condition and live longer, happier life. Along with useful information about foods that raise, lower, and help with high cholesterol, the author has a number of helpful chapters, such as a list of foods to avoid to immediately begin lowering cholesterol, knowing the tell tale signs of a heart attack, and healthy recipes which will immediately lower your cholesterol levels. Like all the other Blue Heron Health News promoted health guides, the Beat Cholesterol in 30 Days guidebook will help you achieve better health using an all-natural method. Unlike most prescription drugs, this program ensures a risk-free solution to a reduced cholesterol level in a short span of time. This book will provide you with all there is to know about your silent killer enemy: cholesterol. Read more here...

Natural Cholesterol Guide Overview


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Author: Scott Davis
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My Natural Cholesterol Guide Review

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Ezetimibe and Statins

All of the in vivo data described thus far involve animals fed diets that are substantially higher in fat and cholesterol than the animals' normal chow diet. Despite the substantial activity of ezetimibe and other azetidinone CAIs in these models, none of the compounds tested significantly reduced plasma cholesterol levels in animals fed a normal chow diet. While this was initially a concern, this observation ultimately led to one of the most important aspects of the profile of ezetimibe. In considering the possible reasons for the lack of substantial effect on serum cholesterol in the absence of a high cholesterol diet, Davis reasoned that a CAI might stimulate hepatic hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase activity. This could compensate for a reduced cholesterol load due to inhibition of intestinal cholesterol absorption. If this were the case, then coadministration of a CAI and an HMG-CoA reductase inhibitor should produce an enhanced reduction in serum cholesterol...

Clinical efficacy of hydroxymethylglutarylcoenzyme A reductase inhibitors statins as lowdensity lipoprotein

Statins represent a class of drugs that specifically inhibit hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase, an enzyme that catalyzes the rate-controlling step in de novo cholesterol biosynthesis.34 Two general classes of statin have been identified the earlier natural product-based statins (mevastatin 1, lovastatin 2, simvastatin 3, pravastatin 4 Figure 7) and the more recent new generation of synthetic statins (atorvastatin 6, fluvastatin 5, cerivastatin 7, rosuvastatin 8, pitavastatin 9 Figure 7). Since their initial discovery in the mid-1970s, multiple statins have been

Safety concerns with statins

Data from animal studies have indicated that pronounced inhibition of cholesterol biosynthesis with high doses of statins induced multiple toxic side effects, including liver enzyme elevations, cataracts, skeletal muscle changes, central nervous system lesions, and certain tumors. However, overall, good safety and tolerability have been observed for the first- and second-generation statins in multiyear clinical trials, and millions of patients have been safely treated with approved doses of these agents. Withdrawals due to adverse events from statins in several multiyear trials were similar to placebo, and the overall incidence of clinically significant adverse events has been quite low. Initial concerns about cataract formation are no longer considered a significant safety issue since several clinical studies monitoring optical lens opacity with the early statins showed that these occurred at the same rate in both statin-treated and placebo groups. Since statins target cholesterol...

Combinations of statins and cholesterol absorption inhibitors

The complementary nature of the two inhibitory mechanisms targeting HMG-CoA reductase and cholesterol absorption suggests that combinations of these agents may have additive or perhaps even synergistic clinical benefits. The first clinical evidence supporting this hypothesis was observed from the additional lipid lowering that could be achieved by using ezetimibe as an add-on therapy to patients who are already taking statins. In this study, 10 mg ezetimibe was given to patients on stable simvastatin therapy. The addition of 10 mg ezetimibe produced an additional 25 reduction in LDLc, indicating a significant synergistic effect.53 In another trial, the addition of 10 mg of ezetimibe to 10 mg atorvastatin achieved > 50 reduction in LDLc, comparable to that seen with an 80 mg dose of atorvastatin alone. Thus, combinations of statins with ezetimibe offer the opportunity to lower significantly the statin dose needed to achieve lipid targets, perhaps with potentially increased safety.

Antioxidants in combination therapy with statins

Several clinical studies have examined antioxidants in combination with various statins. However, no significant beneficial effects in coronary event reduction were achieved by adding vitamin E to simvastatin, pravastatin, or atorvastatin. Notably, in the secondary prevention HDL Atherosclerosis Treatment (HATS) trial, treatments with antioxidants such as vitamin E, vitamin C, and beta-carotene were compared alone or in joint therapy with a combination of simvastatin 3 and niacin 17. In contrast to the lipid-lowering effects and reduction in coronary events observed with the simvastatin niacin combination alone, antioxidants by themselves demonstrated no significant benefit in disease progression and coronary outcomes. However, the beneficial effects of simvastatin niacin on lipid lowering and disease progression were essentially negated when this combination was administered together with antioxidants. Thus, supplementation with antioxidants produced a significant negative outcome...

Hydroxymethylglutaryl Coenzyme A Reductase Inhibitors Statins

Statins specifically target and potently inhibit HMG-CoA reductase, the enzyme that catalyzes mevalonate formation and represents the rate-controlling step in de novo cholesterol biosynthesis (Figure 7).34 No toxic metabolites accumulate as a result of the inhibition of HMG-CoA reductase. HMG is water-soluble and has a number of metabolic pathways available to preclude buildup of this intermediate. However, in vivo, the resulting decrease in mevalonate that occurs from inhibition of HMG-CoA reductase reduces the overall concentration of the steroid pool. In response to this depletion, HMG-CoA reductase expression increases and the hepatic LDLr is upregulated. Approved statins (Figure 7) consist of two subclasses the early first-generation natural product-derived or their related semisynthetic analogs (mevastatin 1, lovastatin 2, simvastatin 3, pravastatin 4), and the newer second- and third-generation synthetic analogs containing a central core aromatic heterocycle (atorvastatin 6,...

Limitations of Low Density Lipoprotein Cholesterol Reduction and Statin Therapy

A clear overall therapeutic benefit has been achieved by lowering LDLc with multiple statins in a subset of patients with established CHD and in primary prevention for high-risk patients. Based upon these positive benefits, statin use has increased such that recent population studies now indicate that in 2002 over 9 of the US adult population were taking some form of statin.77 However, even in controlled clinical settings, the majority of patients fail to reach their projected lipid levels and significant numbers of patients fail to achieve a therapeutic benefit as they continue to experience major coronary events while continuing statin treatment. While coronary event reductions of 25-30 are observed with statins as monotherapy, in secondary prevention trials, nearly 70 of the patients have coronary events that are not avoided. Thus, the search has continued for alternative strategies to lower LDLc or to increase the clinical effectiveness of statins using combination therapies. In...

Combinations of statins with highdensity lipoprotein cholesterolelevating agents

While statin therapy offers a significant therapeutic benefit to the subset of patients that respond to these agents, typically, more than 60 of the statin-treated patients in controlled trials continued to develop cardiovascular disease and failed to experience a therapeutic benefit.34 Most of these nonresponders also had low HDLc levels. Since statins produce only modest increase of HDLc (< 10 ),34 several studies have been conducted to define the potential benefit using statins in combinations with either fibrates or niacin. For example, in the HATS secondary prevention trial, CHD patients with low HDLc (< 31 mgdL_ 1) and normal LDLc levels were treated with a combination of simvastatin and niacin. This combination produced an elevation of 26 in HDLc and a surprising 42 reduction in LDLc. These combined effects on lipids were accompanied by a remarkable 60-90 reduction in CHD events. Since this was a small trial, it would be useful to have these results confirmed in a larger...

Medications for High Cholesterol

Sometimes, despite making changes to their diet, some people continue to have excessive serum cholesterol concentrations. This situation occurs in patients with the nephrotic syndrome, and in those diabetics who have relatively high rates of protein excretion. These high serum cholesterol levels usually can be treated readily in patients with and without renal failure, including people with diabetes, by the administration of a statin drug. These drugs are just as effective in renal disease as in its absence, and no more toxic. They are being used more and more widely, and seem to have other beneficial effects some may reduce the incidence of Alzheimer's disease, and some may reduce the incidence of osteoporosis. Also, muscle damage can occur from statins and can lead to the release into the blood of a protein from damaged muscle, myoglobin, that can cause the kidneys to shut down entirely. This form of acute renal failure has caused the deaths of a number of patients and recently has...


HMG-CoA reductase inhibitors, the so-called statins, are currently being tested in clinical trials for their efficacy as MS therapeutics,34 and for their ability to reduce cholesterol in adolescents with SLE (see Figure 1 and Table 2). Beyond their cholesterol-reducing properties, statins have pleiotropic effects - including anti-inflammatory and neuroprotec-tive properties. In preclinical studies, statins inhibited the onset and progression of disease in EAE by inducing a shift from Th1 (proinflammatory) toward Th2 (anti-inflammatory) cytokine production. In vitro studies suggest that statins inhibit lymphocyte migration across the blood-brain barrier. Further, statins may promote remyelination. In an open-label study of 30 RRMS patients, a simvastatin regimen decreased lesional activity assessed by MRI, and was well tolerated however, it did not affect EDSS scores or yearly relapse rates.35 Statins have many advantages beside being well tolerated, they are administered orally, have...

Cholestyramine resin

koh-less-TEER-ah-meen Alti-Cholestyramine Light M, Lo-Cholest, Novo-Cholaine Light M, PMS-Cholestyramine M, Prevalite, Questran, Questran Light Rx Classification Hypocholesterolemic agent, bile acid sequestrant Action Kinetics Binds sodium cholate (bile salts) in the intestine thus, the principal precursor of cholesterol is not absorbed due to formation of an insoluble complex, which is excreted in the feces. Decreases cholesterol and LDL and either has no effect or increases triglycerides, VLDL, and HDL. Also, itching is relieved as a result of removing irritating bile salts. The antidiarrheal effect results from the binding and removal of bile acids. Onset, to reduce plasma cholesterol Within 24-48 hr, but levels may continue to fall for 1 yr to relieve pruritus 1-3 weeks relief of diarrhea associated with bile acids 24 hr. Cholesterol levels return to pretreatment levels 2-4 weeks after discontinuance. Fat-soluble vitamins (A, D, K) and possibly folic acid may have to be...

The Benefits of Exercise

Along with a healthy diet, exercise is the cornerstone of good health. Physical activity produces a multitude of benefits for your overall health and well-being. Being active helps prevent heart disease and stroke by lowering cholesterol levels and making the heart pump more efficiently. It reduces the risk of dying prematurely, especially of heart disease. Physical activity helps control your weight and prevent obesity, which is a risk factor for high blood pressure and diabetes. Regular exercise also can improve your mood, reduce stress, and relieve depression, not to mention build muscular strength and tone, increase your flexibility, Before beginning any new exercise program, always consult with your doctor if you are over age 40, smoke, or have any risk factors for heart disease, including high blood pressure, a high cholesterol level, diabetes, or a family history of heart disease.

Healthy Diet Guidelines

For example, if you have a high cholesterol level and a family history of heart disease, your doctor probably will recommend that you lower your intake of high-fat foods. On the other hand, if you have a family history of diabetes and are overweight, your doctor probably will advise that you go on a weight-loss diet. A family history of colon cancer might prompt your doctor to advise you to reduce your consumption of red meat. raises your risk for heart disease and stroke. Whole-grain foods that are high in fiber can help improve cholesterol levels and maintain a healthy digestive system. Grains, vegetables, and fruits contain an abundance of nutrients, such as essential vitamins and minerals, many of which have disease-preventing properties. It is important to eat a wide variety of foods to make sure that you are consuming as many of these nutrients as possible.

Antihyperlipidemic Agentshmgcoa Reductase Inhibitors

Atorvastatin calcium Cerivastatin sodium Fluvastatin sodium Lovastatin Pravastatin sodium Simvastatin General Statement The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults has developed guidelines for the treatment of high cholesterol and LDL in adults. Cholesterol levels less than 200 mg dL are desirable. Cholesterol levels between 200 and 239 mg dL are considered borderline-high while levels greater than 240 mg dL are considered high. With respect to LDL, levels less than 130 mg dL are considered desirable while levels between 130 and 159 md dL are considered borderline-high and levels greater than 160 mg dL are considered high. Depending on the levels of cholesterol and LDL and the number of risk factors present for CAD, the provider will develop a treatment regimen. Action Kinetics The HMG-CoA re-ductase inhibitors competitively inhibit HMG-CoA reductase this enzyme catalyzes the early rate-limiting...

Epidemiologic Studies

It is well established that LDL and total cholesterol levels are correlated according to the exponential curve with the risk of CHD. Simultaneously, there is a negative correlation between high-density lipoprotein (HDL) cholesterol and Studies performed by Sacks et al. (5) and other investigators (6) demonstrate that total, very low-density lipoprotein (VLDL) and LDL cholesterol levels are significantly higher in nonvegetarians than in matched vegetarian controls. Although the HDL-cholesterol levels also are higher in nonvegetarians, the ratio of HDL cholesterol to total cholesterol is significantly lower compared to vegetarians. Additionally, blood triglyceride levels in nonvegetarians are significantly higher than in vegetarians. Simultaneously, the prevalence of CHD in nonvegetar-ians is higher than in vegetarians (7).

Clinical and Metabolic Studies

It should be mentioned that Hillman et al. (14) demonstrated the consumption of diet supplemented with lignin by persons with hypercholesterolemia is associated with a decrease of total cholesterol concentration in the blood. However, in persons without disorders of lipid metabolism lignin has no such effect. Studies performed in vitro demonstrate that lignin binds bile acids (15). The hypocholesterolemic action of lignin may be the result of binding bile acids in the intestinal lumen. This mechanism is similar to cholestyramine or plant sterols that have a marked hypocholesterolemic effect in persons with hypercholesterol-emia (16). Although different doses of fiber were used in these separate studies it appears from these summaries that the water insoluble components of dietary fiber are relatively ineffective in lowering the total cholesterol concentration in blood in humans, while the water soluble components are moderately effective. added to the diet as purified preparations of...

Roles of Transporters in Pharmacokinetics

Hepatocyte Sinusoidal Membrane Apical

This huge network of hepatobiliary transporters can give rise to variations in drug disposition between individuals by modulating the uptake or the exit of drugs and their metabolites from hepatocytes. A change in hepatic uptake may have clinical consequences. It may modulate the pharmacological activity of drugs that act via the intrahepatocellular transduction pathways, it may cause hepatotoxicity, or give rise to drug-drug interactions. The concentration of the cholesterol-lowering HMGCoA inhibitors in hepatocytes must be adequate for their pharmacological activity, and most of the statins (e.g., pravastatin, simvastatin, lovastatin, cerivastatin, and pitavastatin) enter hepatocytes via OATP1B1, and to a lesser degree via OAT1B3.131 Recently identified genetic polymorphisms like the SLCO1B3 haplotype *17 are associated with reduced statin clearance by the liver and lower concentrations in hepatocytes they thus have less effect on cholesterol synthesis.132 Large-scale clinical...

Common Screening Tests

Cholesterol Levels Elevated levels of the fats known as cholesterol in your 89 Cholesterol comes in two forms low-density lipoprotein (LDL), the bad cholesterol, and high-density lipoprotein (HDL), the good cholesterol. Somewhat like a delivery truck, LDL cholesterol carries most of the fat in your blood and deposits the excess inside your artery walls. Like a garbage truck, HDL cholesterol removes fat from your blood, preventing it from building up in your arteries. When testing your cholesterol levels, your doctor measures your total blood cholesterol as well as your LDL and HDL levels by taking a sample of your blood and having it analyzed in a laboratory. A desirable total blood cholesterol level falls under 200 milligrams per deciliter of blood. Doctors consider cholesterol levels above 200 to be high. One in five Americans has a total cholesterol level of 240 or greater, placing that person at risk of a heart attack. Your LDL cholesterol levels should be under 100, and HDL...

Generalization Of Controlled Randomized Trials

In early 1970s, a high cholesterol level was known to be a risk factor for developing coronary heart disease. To confirm this, a trial known as the Lipids Research Clinics Coronary Primary Prevention Trials (CPPT) was initiated by the National Heart, Lung, and Blood Institute to test the hypothesis whether lowering cholesterol can prevent the development of coronary heart disease. In the CPPT trial, a total of 4000 healthy, middle-age males were randomized to receive either the cholesterol-lowering agent cholestyramine or its matching placebo (Lipids Research Clinics Program, 1984). The primary endpoint was the incidence of coronary heart disease after a seven-year follow-up. A statistically significant reduction of 1.7 in 7-year incidence of coronary heart diseases was observed for the cholestyramine group as compared to the placebo (8.1 versus 9.8 ). An expert panel recommended to extrapolate the results for the treatment of high cholesterol in populations that had never been...

The Design of Ezetimibe

In parallel, we studied the synergistic effect of ezetimibe, along with a statin for lowering cholesterol levels. Thus, ezetimibe (0.007 mgkg_ and lovastatin (5mgkg_ were administered orally to two different sets of chow-fed dogs for 14 days. Neither ezetimibe nor lovastatin showed significant activity however, the combination showed a dramatic reduction in serum cholesterol levels (Figure 6). Based on all these results, ezetimibe has progressed to the clinic as a monotherapy agent and also in combination with simvastatin. The combination drug, named Vytorin, was jointly developed by Schering-Plough and Merck. Based on all these observations, ezetimibe was advanced alone and also in combination with simvastatin and atorvastatin in the clinic, and the results are presented in Figure 7. In the clinic,10-13 ezetimibe (10 mg) when administered alone reduced serum cholesterol levels by 18.5 , on average, and in combination with simvastatin (10 mg), serum cholesterol levels were reduced by...

Cape myrtle Myrsine africana Myrsinaceae

Aerial parts of this evergreen shrub are collected and used as additives in meat and milk-based soups by the Batemi and Masai of east Africa. Saponin-like compounds contained in Cape myrtle, which forms a significant part of the Masai diet, are believed to inhibit absorption of dietary cholesterol, thus helping the indigenous people, who consume large amounts of meat, to remain healthy. The flowers of this species are also eaten, whereas the fruit is said to be used as a treatment for intestinal worms.

Figure 15 Structure of the cofactor undine5diphosphoaDglucuronic acid 39 UDPGA generic reactions of O and

An important pathway of O-glucuronidation is the formation of acyl-glucuronides (Figure 15a). Substrates are numerous nonsteroidal anti-inflammatory arylacetic and 2-arylpropionic acids (e.g., ketoprofen, 43 in Figure 16) and aliphatic acids (e.g., valproic acid, 44 in Figure 16). More recent drug classes such as statins and endothelin receptor antagonists may also yield acyl-glucuronides. Aromatic acids do not appear to be good substrates, but there are exceptions. The significance of acyl-glucuronides has long been underestimated. Indeed, these metabolites are quite reactive, rearranging to positional isomers and binding covalently to plasma and seemingly also tissue proteins.84,85 Thus, acyl-glucuronide formation cannot be viewed solely as a reaction of inactivation and detoxification.

Genetic Considerations

Combination of genetics and environment appear to account for the vast majority of cases of CAD. First-degree relatives of CAD patients are at higher risk of developing the disease and developing it earlier than the general population. Over 250 different genes have been implicated in the onset of CAD, making it a prime example of the combination of multiple genes and environment seen in complex disease. Defects in genes involved with LDL metabolism, homocysteine metabolism, and blood pressure regulation have been associated. Other genes that have been linked encode apolipoprotein A1 and glycoprotein IIb IIIa. Familial hypercholesterolemia is due to a defective LDLR and is inherited in an autosomal dominant pattern. LDL levels elevated to values double that of normal are seen in affected persons as early as 2 years of age and signs of CAD can be found by age 30.

Background and Introduction

ERT gained widespread popularity in the US in the 1960s and early 1970s26-28 and, by 1974, approximately 28 million prescriptions were filled for noncontraceptive use of estrogens. Previous studies have shown that ERT slows the rate of postmenopausal bone loss22,29 and reduces the incidence of osteoporotic fractures,22 and until recently, it was generally believed that ERT might be beneficial for reducing the risk of heart disease.30,31 The idea that ERT might have cardioprotective effects was based on observational studies32-37 which suggested that women who take estrogen have a lower risk of CHD compared to women who do not take estrogen. Previous studies38-40 have shown that estrogen therapy reduces plasma levels of the 'bad cholesterol' low-density lipoproteins (LDL) and increases the levels of the 'good cholesterol' high-density lipoproteins (HDL), changes that are associated with a reduced risk of cardiovascular disease. Estrogen also prevents oxidation of LDL cholesterol, which...

Raloxifene and Lipids

Estrogen increases HDL cholesterol levels and decreases LDL cholesterol levels in humans39,171 as well in animal models of atherosclerosis, partly because of estrogen receptor-mediated upregulation of the hepatic LDL receptor.172 In ovariectomized rats, raloxifene treatment has been shown to reduce serum total cholesterol concentrations,97,173 and this reduction correlates with the extent of raloxifene binding to the estrogen receptor.97,173 These results are not surprising for a 'nonsteroidal antiestrogen,' as the original observations for clomiphene analogs and tamoxifen show (see 8.08 Tamoxifen). Raloxifene may also have cardioprotective effects because of its antioxidant properties. This is important since oxidative modifications of LDL have been implicated in atherogenesisis.174 Raloxifene also appears to have a favorable effect on lipid parameters in postmenopausal women. In the published European trial,78 treatment with raloxifene in a dosage of 30, 60, or 150 mg day_ 1...

Antiinflammatory compounds Statins Dietary cholesterol affects the formation of Ab and accelerates the appearance of AD pathology in mouse models high serum cholesterol and low high-density lipoprotein cholesterol levels are AD risk factors.57 Cholesterol-lowering agents, e.g., statins, are of interest as treatments for AD. These agents inhibit b-hydroxy-b-methyl glutaryl-CoA reductase, a key regulatory enzyme in the cholesterol biosynthetic pathway. Atorvastatin 49, evaluated in an intention-to-treat clinical trial, showed positive benefit in ADAS-cog performance at 6 months.58 An observational study of AD patients treated with lipid-lowering agents, 47 of which were statins, showed a positive benefit (i.e., slower decline) on the MMSE.59 Thus, with further study statins may become standard therapy.

Other Selective Estrogen Receptor Modulators

Current interest in new SERM molecules has built on the experience of the prototypes with the goal of enhancing bioavailability and selectivity and decreasing side effects (i.e., breast cancer, uterine cancer, and blood clots). All compounds under study have predominantly antiestrogenic effects in the rodent uterus with virtually no estrogen agonist properties. In order to improve upon the raloxifene pharmacophore, some groups have reported on the effect of modifying the benzothiophene nucleus. Particularly noteworthy were two discoveries made by the chemists at Eli Lilly which improved upon raloxifene.77 One change involved the introduction of a methyl ether on either the 5-OH or the 4'OH position, which resulted in compounds with increased potency in a cholesterol reduction assay in ovariectomized rats.178'179 The other change involved the replacement of the carbonyl 'hinge' with other atoms or groups, including N, CH2, S, and O. The change to the oxygen atom resulted in a compound...

Metabolic derangements that accompany liver failure

Primary biliary cirrhosis middle-aged woman with no risk factors for liver or biliary disease, marked, pruritus, jaundice, and positive antimitochondrial antibodies rest of work-up is negative. Cholestyramine helps with symptoms, but no treatment (other than liver transplantation) is available.

Mechanisms responsible for the overexpression of pai1 in diabetes

The exposure of human hepatoma cells to gemfibrozil decreases basal and insulin-stimulated secretion of PAI-1 (121). This inhibitory effect has been observed in vitro but not in vivo (122,123) despite reductions in vivo in the concentration of triglycerides in blood by 50 to 60 . No changes in insulin sensitivity or concentrations of insulin in the blood were seen after treatment of patients with gemfibrozil. Thus, unlike therapy with agents that reduce insulin resistance and lower concentrations of insulin, therapy with gemfibrozil that reduces triglycerides without affecting concentrations of insulin does not lower PAI-1 in vivo. These observations support the likelihood that insulin is the critical determinant of altered expression of PAI-1 in subjects with insulin resistance such as those with type 2 DM. As judged from results in studies in which human hepatoma cells were exposed to insulin and triglycerides in vitro, modest elevations in the concentrations of triglycerides and...

Chemical Biology and Chemical Genomics

Combinatorial biosynthesis has been exploited for many years through natural products. More recently, a number of academic and industrial groups have managed to harness some of these processes to produce new collections of related molecules. Progress is particularly evident in the production of classes of polyketides and nonribosomal peptides that have proven useful in pharmaceutical and agricultural products. Examples include antibiotics such as erythromycin, penicillin, rifamycin, and vancomycin, as well as anticancer drugs, cholesterol-lowering agents, and other important classes of pharmaceuticals. Now it is possible to exploit controlled biological manipulations to effect Claisen-like condensations, cyclizations, decarboxylations, dehydrations, epimerizations, reductions, and other chemistries in order to produce new analogs that would otherwise be very difficult to prepare synthetically (Figure 36).222-223

Effects of Estrogen on Lipids and Lipoproteins

Oral estrogen reduces plasma total and low-density lipoprotein (LDL) cholesterol by 5 -15 , increases high-density lipoprotein (HDL) cholesterol by 10 and reduces lipoprotein(a) Lp(a) levels. A potentially adverse effect of oral estrogen is an increase (20 -25 ) in plasma triglycerides (50). The mechanisms of estrogen actions involve enhanced catabolism and clearance of LDL by increasing the number of LDL (apo-B E) receptors in hepatocytes, decreasing hepatic HDL receptors and reducing activity of hepatic lipase, thereby raising levels of HDL-cholesterol (HDL-C, mostly HDL-C2) and enhancing biliary excretion of cholesterol (59,60). The overall effect, therefore, is to reduce cholesterol accumulation in peripheral tissues and to increase its biliary excretion.

Genes and the Metabolic Syndrome Complex Trait Genetics

For instance, in certain North American aboriginal communities, such as the Oji-Cree of Ontario, the combined prevalence of impaired glucose tolerance and type 2 diabetes is approximately 40 .40 This development has been inextricably linked with the recent doubling of hospitalizations for coronary heart disease among Oji-Cree, despite declining rates in the general Canadian population.41 Among Oji-Cree adults aged 35 and older, 43 had MetS.42 Furthermore, 8.7 of female Oji-Cree adolescents had MetS, as defined by the NCEP Adult Treatment Panel (ATP) III47 criteria. Increased waist girth and depressed HDL cholesterol were the most prevalent individual components in subjects with MetS. Common functional polymorphisms in genes encoding proteins involved in the renin angiotensin system, the G-protein family (GNB3) and components of triglyceride-rich lipoproteins were each significantly associated with MetS in Oji-Cree adults, especially women.43 Such studies suggest that...

Insights into Metabolic Syndrome Progression from the Monogenic Disorders

Nondiabetic FPLD2 subjects have high plasma insulin, triglycerides, free fatty acids, and CRP, together with low plasma HDL cholesterol and adiponectin long before diabetes developed.43 Thus, the characteristic cluster of biochemical abnormalities precedes the relatively late decompensation of glycemic control among carriers predisposed to lipodystrophy. A similar pattern of progression - i.e., early hyperinsulinemia with dyslipidemia and altered adipocytokines followed by hypertension and finally diabetes - may be important in 'garden-variety' MetS. In both cases, spillover of FFA from adipose tissue and uptake and storage viscerally and in ectopic sites, such as muscle and liver, may be a key inciting pathophysiological event. In FPLD, spillover of free fatty acids occurs because there is an anatomical absence of the peripheral subcutaneous fat buffer. In 'garden-variety' MetS, this spillover occurs because peripheral fat stores become saturated. If this pattern of metabolic...

Management of the Metabolic Syndrome

Finally, because of the heightened risk of vascular disease, MetS patients should receive other broad-spectrum preventive treatments such as aspirin. The targets for lipids and blood pressure should follow guidelines and recommendations for higher-risk patients. The treatment of the atherogenic dyslipidemia in MetS is aimed at correcting the fundamental disturbances - namely reducing plasma triglycerides and raising plasma HDL cholesterol. Among currently available agents, the fibrates, which are PPAR-g agonists, are best at normalizing MetS dyslipidemia. In contrast, statins target LDL cholesterol, but their role in vascular disease prevention is supported by a much wider evidence base. Many clinicians will first choose a statin as dyslipidemia therapy for MetS patients, especially when triglycerides are only mildly elevated. Other treatment alternatives include the judicious use of niacin preparations and also combinations of a fibrate, statin, and or cholesterol absorption...

Primary Nursing Diagnosis

Most patients are diagnosed and treated on an outpatient basis. The goal of treatment is to return the patient to the euthyroid (normal) state and to prevent complications. The treatment of choice is to provide thyroid hormone supplements to correct hormonal deficiencies. Treatment of the elderly patient is approached more cautiously because of higher risk for cardiac complications and toxic effects. The medication should not be given if the pulse rate is greater than 100. The treatment is considered to be life-long, requiring ongoing medical assessment of thyroid function. Polypharmacy is a significant concern for the hypothyroid patient. Several classifications of drugs are affected by the addition of thyroid supplements, including beta blockers, oral anticoagulants, bronchodilators, digitalis preparations, tricyclic antidepressants, and cholesterol-lowering agents.

Fat Intake And Disease

Conversely, diets rich in saturated fats increase the ratio of LDL-cholesterol to HDL-cholesterol increasing the risk of a coronary heart disease incident (9,10). However, it is not quite as simple as it seems because different saturated fats and dietary sources of saturated fat have different influences on the level of LDL-cholesterol (11). For example, dairy products which are high in myristic acid (14 0) appear to increase levels of LDL-cholesterol whereas beef fat, containing palmitic (16 0) and stearic (18 0) acids, do so to a lesser extent and cocoa butter, with a high proportion of stearic acid, increases LDL-choles-terol only slightly. This would strongly indicate that other dietary constituents are interacting and playing a vital role in this process.

Benefits of Glycemic Control

The DCCTand UKPDS demonstrated the benefits of glycemic control on the prevention of diabetic microvascular complications and potential benefit in diabetes-associated CVD. Independently, diabetes is a risk factor for CVD morbidity and mortality equivalent to having pre-existing coronary artery disease. Therefore, the treatment goals for modifiable cardiac risk factors, specifically blood pressure and abnormal lipid levels, are more aggressive in individuals with diabetes55 (Table 5). The ADA recommends a goal blood pressure of < 130 80 mmHg, LDL cholesterol of < 100mgdL_ 1 (< 70mgdL_ 1 in individuals with known coronary artery disease), HDL cholesterol of > 40mgdL_ 1 (> 50 mgdL_ 1 in women), and triglycerides < 150 mgdL_ 1. aHbA1C is the primary target for glycemic control. Glycemic goals should be individualized, with certain populations (children, pregnant women, and elderly) receiving special considerations, and less intensive glycemic goals in patients with severe or...

HRT and Genetic Factors

Thus the estrogen associated risk for thrombosis may be increased in the presence of the prothrombin 20210 G A variant, the factor V Leiden mutation or platelet antigen-2 polymorphisms (95-97). A common sequence variation of the ER gene is associated with the magnitude of the response of HDL cholesterol levels to HRT in women with coronary disease (19). The same ERP genotype is also related to changes in the levels of SHBG, another index of estrogen action (95). It is also interesting that in the HERS trial high levels of Lp(a), which is largely genetically determined, were an independent risk factor for CHD events in the placebo group. HRT lowered Lp(a) levels and the cardiovascular benefit of HRT was significantly related to the initial Lp(a) levels and the magnitude of the reduction in the level (98). It appears therefore, that genetic factors may also contribute to the net clinical effect of HRT regarding CVD in postmenopausal women.

Interpretation of the statistical analysis

Look at the results table again, then you can see that above the critical two-tail value Excel has returned the actual probability value for the analysis. This value is 0.5748, i.e. the test has proved there is no significant difference between the two margarine diets that were used, as the level of significance from the analysis is 57.5 per cent. We therefore accept the null hypothesis that there is no difference in the cholesterol levels for the subjects taking the two dietary treatments. Although a significant result has not been obtained, the experiment has not PROVED conclusively that the dietary margarine did not have an effect on serum cholesterol. The experiment was performed once, in a small number of subjects. Although this gives weight to the argument that the diet did not have any effect, the more times the experiment is repeated and a similar result obtained, the more likely it is that the hypothesis is correct. We could also improve upon the design of the experiment by...

Mechanisms of action

When used as monotherapy, acarbose and miglitol are not associated with hypoglycemia or significant weight changes. Blocking the absorption of complex carbohydrates decreases the caloric uptake of the small intestine, but the large intestine compensates to assure that adequate caloric goals are met. a-Glucosidase inhibitors do not significantly affect LDL or HDL cholesterol concentrations, but triglyceride levels decline. These agents may prove to be useful in the management of severe hypertriglyceridemia in both the diabetic and non-diabetic population.

Comparisons of rosiglitazone and pioglitazone

In vitro studies reveal that pioglitazone acts as a PPAR-g and partial PPAR-a agonist, whereas rosiglitazone is only a PPAR-g agonist. This difference may explain their different effects on lipid metabolism.73 Both rosiglitazone and pioglitazone improve HDL cholesterol levels by approximately 10 . Rosiglitazone is associated with an increase in LDL cholesterol concentration of 8-16 , which has not been seen with pioglitazone therapy. On the other hand, pioglitazone is associated with a decrease in triglyceride levels that has not been seen with rosiglitazone. Both agents decrease serum FFA concentrations by approximately 20-30 .

Dyslipidemia as a Risk Factor for Coronary Heart Disease

While smoking, hypertension, age, obesity, diet, and family history all contribute to CHD, dyslipidemia is one of the most prominent risk factors for this disease. Historically, CHD has often been considered a disease primarily associated with hyperlipidemia, i.e., high plasma cholesterol levels, particularly cholesterol associated with low-density lipoprotein (LDLc).4 Indeed, atherosclerotic plaques taken from heart transplant patients contained significantly higher percentages of cholesterol (19-26 +10 ) than nonatherosclerotic coronary tissue taken from the same donors (4 + 3 ).5

Polycystic Ovary Syndrome and Cardiovascular Risk

Women with PCOS have higher serum triglycerides, total and LDL cholesterol and lower HDL cholesterol levels than weight-matched regularly menstruating women (190). These findings however, vary and depend on the weight, diet and ethnic background. In a large study of non-Hispanic white women, elevated LDL-C was the predominant lipid abnormality in women with PCOS (191). An additional parameter contributing to the elevated cardiovascular risk is hypertension. Obese women with PCOS have an increased incidence of hypertension and sustained hypertension is threefold more likely in later life in women with PCOS (192). It is not clear whether this increase in hypertension is because of the PCOS status, obesity or both.

Low Density Lipoprotein Cholesterol and Coronary Heart Disease Risk

The link between elevated plasma total cholesterol levels, high LDLc, and increased CHD risk has been known from epidemiological studies since the early 1980s. The Framingham Study followed over 5000 males and females, monitoring plasma lipid levels and the incidence of MI. In this cohort, subjects with elevated serum cholesterol ( > 275 mgdL_ 1) had more adverse events whether they were healthy or already had CHD. The prevalence of plasma cholesterol levels above 240 mgdL_ 1 in subjects who experienced an MI was 35-52 in males and 66 in females.24 LDLc levels in this CHD subpopulation were well above 100mgdL_ 1 and were most prevalent at 160mgdL_ 1 Subjects who experienced an MI and had high plasma cholesterol levels were at increased risk for another MI or death from either CHD or other causes. Total cholesterol levels in FH patients exceed twice the normal range, and can reach higher than 500mgdL_ 1 in homozygous populations. LDL catabolism is dramatically lowered in these FH...

Low Density Lipoprotein Cholesterol Lowering Agents

Plasma cholesterol levels are determined by the balance between dietary intake, de novo biosynthesis, and reabsorption processes in the gut as well as by biliary clearance and excretion. While the majority of plasma cholesterol concentrations are derived from cellular biosynthesis in the body, primarily in the liver, about one-third is accounted for from absorption after dietary intake. Prior to the late 1980s, few alternatives existed to lower plasma cholesterol levels. While changes in lifestyle and diet were recommended, polymeric resins that sequestered bile acids in the gut, such as cholesteryamine and colestipol, were used to lower LDLc. While these agents were extremely safe due to their lack of systemic absorption, the high doses required for clinical efficacy limited patient compliance. Even at maximal doses of grams per day, these resins only achieved LDLc reductions of no more than 25 . Over the last 25 years, tremendous progress has been made in providing alternatives for...

Clinical efficacy of cholesterol absorption inhibitors as lowdensity lipoprotein cholesterollowering agents

Since dietary intake accounts for up to a third of plasma cholesterol levels and a redundant system in the enterohepatic recirculation is used to reabsorb and conserve cholesterol-derived bile acids and steroidal intermediates, various inhibitors of cholesterol absorption have been explored to identify alternative lipid-lowering agents. Such agents should provide an advantage over a simple low-fat diet and have particular benefit for patients who either do not respond or are unable to tolerate statin therapy. Ezetimibe 10 represents the first cholesterol absorption inhibitor approved for LDLc lowering. In clinical studies, daily doses of 0.25-10 mg of ezetimibe as monotherapy were safe and well-tolerated, and did not alter the plasma concentrations of lipid-soluble vitamins. In this study, ezetimibe dose-dependently lowered plasma LDLc, and the 10 mg dose lowered LDLc by 17-18 in hypercholesterolemic patients after 12 weeks of dosing.52 There was no statistically significant change in...

High Density Lipoprotein Cholesterol Elevating Agents

Epidemiological studies clearly indicate that low HDLc (< 40mgdL_ 1) represents a significant independent risk factor for CHD. While statin therapy effectively lowered LDLc by up to 45 , statins generally produce only very modest increases in HDLc levels, usually less than 10 .34 Currently, only two alternatives are available for treating low HDLc fibrates and niacin-based (Figure 8) therapies. Fibrates increase HDLc by 10-15 , but have a more pronounced effect on TG lowering. Fibrates have been available since the early 1970s. The fibrate mechanism of action

Calendar Time And Information Time

At the planning stage the sample size is usually calculated based on information regarding the expected difference between treatments, its corresponding variability, and the desired statistical power for a predetermined risk of type I error. After the study is initiated, patients are enrolled to receive the treatment for a fixed length of time until he or she reaches either the end of the study or the time of analysis with survival as one of the primary endpoints. The Postmenopausal Estrogen Progestin Interventions (PEPI), for example, is a trial funded by the U.S. National Institutes of Health to evaluate the effects of unopposed estrogen and combined estrogen-progestin therapy on four major cardiovascular disease risk factors in postmenopausal women (Espeland et al., 1995). These four risk factors include plasma HDL-cholesterol, systolic blood pressure, two-hour postoral glucose serum insulin, and plasma fibrinogen. Table 10.5.1 gives the five treatments to be assessed in the PEPI....

Mevastatin and lovastatin

The statin class was first identified in the early 1970s by investigators at Sankyo who discovered that the natural product, compactin (mevastatin 1), isolated from microbial fermentations of Penicillium citrinum in a search for new antimicrobial agents, potently inhibited HMG-CoA reductase and lowered serum cholesterol levels in animals.61 Compactin (Figure 7) also effectively lowered serum total cholesterol and LDLc in heterozygous FH patients. However, development was stopped in 1980 for unknown reasons that may have been related to toxicity issues that were uncovered in longer term animal studies.51

Low Density Lipoprotein Cholesterol Lowering Agents Cholesterol Absorption Inhibitors

Ezetimibe 10 was discovered as part of a program directed at identifying novel ACAT inhibitors for lipid lowering. These azetidinone leads, although weak as ACAT inhibitors, were efficacious in lowering cholesterol in animals, suggesting that they might work by a different mechanism.71-73 This discovery represents a tour de force in lead optimization, driven primarily by increasing in vivo efficacy by minimizing metabolism, and is in sharp contrast to the more common target-directed discovery approaches employed today. The biochemical target for ezetimibe was unknown at the time that discovery efforts began and has only recently been elucidated.74 Ezetimibe 10 has a long half-life, is suitable for once-a-day oral dosing, is rapidly absorbed, and becomes conjugated as its glucoronide metabolite that is excreted in the bile. This mechanism efficiently delivers ezetimibe to its site of action in the intestine, and recycling in the enterohepatic recirculation further insures that a high...

Ileal bile acid transporter IBAT and apical sodiumcodependent bile acid transporter ASBT inhibitors

As an alternative to cholesterol absorption inhibitors, specific inhibitors of the IBAT, also known as the apical co-dependent bile acid transporter are being sought. The IBAT system facilitates the reuptake of bile acids from the intestine, thus conserving the sterol pool. Functionally, an IBAT inhibitor should produce the same physiological effects of LDLc lowering achieved by anionic resins, such as cholestyramine, which sequester bile acids in the gut, without the high grams per day doses that dramatically limit patient compliance with sequesterants. The first entrant in this field, 34 (S-8921 Figure 14), has demonstrated oral efficacy in lowering LDLc with no accompanying change in HDLc at doses as low as 1 mgkg 1 day_ 1.78 Development of 34 has been discontinued as it showed no clinical benefit over existing products.

What Is a Good Drug Target

Before addressing this question an understanding of which criteria define a 'good' drug target and how such targets have been discovered historically is instructive. While biologics, such as peptide and antibody-based drugs, address targets as well, the scope of this chapter is confined to the discussion of drug targets addressed by small molecules. A cynic's definition of a good drug target would be a target which is already successfully addressed by a marketed small molecule such as 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase with Lipitor,4 or BCR-abl with Gleevec.5 However apt this definition may be, it is too subjective and relies heavily on circular reasoning. Instead, a pragmatist would define a molecular target as one with a proven crucial role in causation or symptoms of a human disease, which when targeted in the clinic with a small molecule leads to reversal or diminishment of the disease and or symptoms. Again, this definition invokes the requirement of a...

Gender Ethnicracial And Life Span Considerations

MI is the single largest cause of death among American men and women, including white, African American, and Hispanic Latino populations. The risk of MI increases with age, and it occurs most commonly in people older than 45 years of age. MIs also occur in young adults, such as individuals who use cocaine, those who are insulin-dependent diabetics, and those who have hypercholesterolemia and a positive family history for early coronary disease.

J A Sikorski Athero Genics Alpharetta Ga Usa 2007 Elsevier Ltd All Rights Reserved Low-Density Lipoprotein Cholesterol-Lowering Agents 472 Clinical efficacy of hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) as low-density lipoprotein cholesterol-lowering agents in patients with coronary Safety concerns with statins 476 Clinical efficacy of cholesterol absorption inhibitors as low-density lipoprotein cholesterol-lowering agents 477 Combinations of statins and cholesterol absorption inhibitors 477 Antioxidants as Monotherapy in Coronary Heart Disease 478 Antioxidants in combination therapy with statins 478 Combinations of statins with high-density lipoprotein cholesterol-elevating agents 479 6.20.5 Current Treatments 480 Low-Density Lipoprotein Cholesterol-Lowering Agents Hydroxymethylglutaryl-Coenzyme A Reductase Inhibitors (Statins) 480 Low-Density Lipoprotein Cholesterol-Lowering Agents Cholesterol Low-Density Lipoprotein...

Unmet Medical Needs

Androgen replacement therapy has been reported to cause water retention, polycythemia, hepatotoxicity, sleep apnea, prostate enlargement, and to reduce HDL cholesterol.3 Hepatic toxicity is associated with derivatives of testosterone rather than pure testosterone. Polycythemia is observed more commonly in males receiving injectable testosterone. Thus, hematocrit should be measured periodically to minimize the risk of polycythemia. HDL cholesterol lowering is more profound with oral methyltestosterone than transdermal or injectable testosterone, but this effect is dose dependent, with higher doses causing more profound lowering of HDL cholesterol. Although testosterone is associated with prostate enlargement and prostate cancer, testosterone replacement therapy is rarely associated with an increase in urinary tract voiding symptoms, leading to cessation of therapy. In addition, prostate cancer surveillance can be done by measurement of PSA during the first 6-month interval after...

Nitrogen Containing Bisphosphonate Inhibition of the Cholesterol Biosynthetic Pathway

Over 15 years ago, it was shown that certain BP derivatives (isoprenoid (phosphinylmethyl) phosphonates) weakly inhibit the cholesterol biosynthetic enzyme squalene synthase.51 The search for more potent inhibitors that might block cholesterol production revealed that the N-BPs incadronate (YM175) and ibandronate potently inhibit squalene synthase.52 Subsequent studies examined the structure-activity relationship (SAR) for inhibition of squalene synthase.53-55 In vivo testing showed that certain compounds suppressed serum cholesterol in rodents.53 Other cholesterol-lowering bisphosphonates were shown to trigger degradation of hydroxymethylglutaryl coenzyme A (HMG-CoA).56-58 In the same context, utility of squalene synthase inhibition by bisphosphonate was also used for the development of an assay to measure zoledronate levels in animals and clinical serum samples.59 Although cholesterol itself is important for osteoclast signaling and survival, the osteoclast relies on low-density...

Nongenomic Actions Extranuclear Actions

Several tissue- and TR isoform-specific compounds have been developed as potential treatments for hypercholesterolemia, obesity, and heart failure reviewed in 96 . In the development of these compounds it is attempted to use information on tissue-specific uptake of the compound. One of the initial compounds was investigated in mice, who subsequently had lower serum cholesterol levels without cardiotoxicity. Recently, several other TH analogs have been described that have compared to TRa. Since thyroid hormone receptors in the liver, isoform-selective affinity for TRp is approximately 90 TRp, and in the heart mostly TRa, these isoform-selective compounds may serve as novel agents to lower serum cholesterol with minimal cardiotoxicity. Recently, KB141 was shown to be a potential treatment for obesity by decreasing body weight via stimulation of metabolic rate and oxygen consumption.

Mechanism of Action at the Cellular Level

The signaling pathways involving geranylgeranylated small GTPases that are affected by bisphosphonates and that lead to osteoclast apoptosis remain to be determined. Perhaps most proximal to the GTPases is the mammalian target of rapamycin (mTOR) ribosomal protein S6 kinase (S6K) signaling pathway.90 Signaling through this path is suppressed when geranylgeranylation is blocked in the osteoclast (Figure 2). Furthermore, specific inhibition of mTOR by rapamycin causes induction of osteoclast apoptosis over a similar time course to that of the N-BPs. Signaling through mTOR represents a relatively novel pathway downstream of receptor activator of NFkb (RANK), tumor necrosis factor alpha (TNF-a), and interleukin-1 (IL-1) signaling in the osteoclast.91,92 Downstream of phosphoinositol-3 kinase, signaling through the Akt kinase to mTOR was originally implicated in maintaining osteoclast survival, putatively through the regulation of protein translation, which itself was shown to be critical...

Results And Discussion

To elucidate more of the so far not fully understood mechanisms behind the effect of treatment with the thia fatty acids, we compared the effect of treatment with thia acids with the sulphur in different positions (Table 1). The main difference between these 16 carbon (17 including the sulphur) fatty acids is their availability for mitochondrial P-oxidation. As already mentioned TTA is blocked for P-oxidation, but can enter the mitochondria, as it is substrate for CPT-I and CPT-II. However, 5-S, 7-S and 9-S can both enter the mitochondria and undergo 1, 2, or 3 cycles of P-oxidation respectively, before they are metabolised into chain-shortened 3-thia fatty acids which cannot be P-oxidised. Evidently, the metabolised forms of 5-S, 7-S and 9-S will accumulate in the mitochondria. In agreement with earlier findings TTA administration lowered plasma triglycerides, 5-S tended to lower plasma triglycerides, but 7-S and 9-S did not effect the plasma triglyceride levels (data not shown). As...

Mechanisms of Renal Dysfunction

Endothelial dysfunction commonly occurs in obesity, type 2 diabetes, and hypertension. The endothelium acts to regulate vascular homeostasis by maintaining a balance between vasodilation and vasoconstriction, inhibition and stimulation of smooth muscle cell proliferation and migration, and inhibition of platelet activation, adhesion, and aggregation.24 Essential hypertension was first recognized to cause endothelial dysfunction early in the last decade where the increase in blood pressure has a direct influence on vascular function independent of other cardiovascular risk factors. Dysfunction of the endothelium could be due to decreased vasodilatory mediators and or increased vasoconstrictor mediators. Factors that lead to reduction of vasodilation and endothelial dysfunction include a reduction in nitric oxide (NO) production, increased oxidative stress, a decrease in NO bioavailability decreased prostacyclin levels, and a reduction of hyperpolarizing factors. Inflammatory responses...

Management of Renal Dysfunction

Aside from the classic treatment of hypertension, an emerging approach to renal dysfunction is the treatment of the components that trigger endothelial dysfunction, e.g., NO bioavailability and oxidative stress. For example, oral treatment with L-arginine, the precursor of NO, reduces blood pressure and improves endothelial dysfunction in hypertensive patients.60 Statins and lipid-lowering drugs improve endothelial dysfunction in hypertensive animal models by enhancing NO levels.61 Antioxidants also can improve endothelial dysfunction in hypertensive animal models. For example, the SOD mimetic tempol decreases hypertension and oxidation stress and improves endothelium-dependent relaxation and kidney damage in hypertensive animal models such as AT-II-infused mice and Dahl salt-sensitive rats.62

Worksite Health Promotion

Health promotion at the worksite covers a wide variety of activities, including exercise and fitness, stress management, smoking cessation, and cholesterol reduction. Specific programs targeting women may include prenatal care, parenting, breast examinations, and mammograms.

Validation of New Methods

Figure 27.4 Sector map display of the MGPS data mining profile for a drug, using a dictionary of medical terms. This display shows the safety profile of cerivastatin, a drug withdrawn from the US market in August 2001 because of reports of fatal rhab-domyolysis, renal failure, and other organ failure 24 . The sector map shows strong signals for several serious muscle events including rhabdomyolysis and for renal failure (note the signals for renal tubular necrosis highlighted in the yellow pop-out note). The strong renal failure signals with this drug were unexpected. In addition, there were huge differences between cerivastatin and other statins regarding the magnitude of the renal failure signals. See color plate.

Parameters of glucose metabolism

Glucose concentration in venous blood Glucose concentration in capillary blood Glucose concentration in plasma Limit for diabetes mellitus in plasma HBAic (glycosylated hemoglobin A) Parameters of lipid metabolism Triglycerides in serum Total cholesterol in serum HDL cholesterol in serum Substances excreted in urine Urea concentration in serum Uric acid concentration in serum Creatinine concentration in serum Bilirubin

Inhibitors of AGE Production

Conversely, hyperglycemia, which increases oxidative stress, can convert even elevated levels of NO to peroxynitrite, which is deleterious to vascular function (179). A decrease in oxidative stress can restore vascular function rather than increase the NO supply. Prolonged hyperglycemia and hypercholesterolemia both cause a depletion of tetrahydrobiopterin (BH4), an essential cofactor for NOS, resulting in an uncoupling of eNOS and lowered production of NO (180). Studies using both diabetic animal models (113) and hypercholesterolemic patients (112) have demonstrated that tetrahydrobiopterin

Angiotensin Converting Enzyme Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors have been shown both to improve endothelial function and to reduce the development of atherosclerosis in various animal models of hypercholesterolemia (192,193), independent of its BP-lowering effect. Similarly, the Heart Outcomes Prevention Evaluation (HOPE) study has demonstrated the utility of the ACE inhibitor ramipril in preventing cardiovascular events in diabetics (194) although the mechanism of this effect remains obscure. Clinical trials have demonstrated that the ACE inhibitor quinapril improved endothelial function in nondiabetic patients with CAD (195). Studies evaluating the effect of ACE inhibitors on type 1 diabetic subjects have resulted in conflicting conclusions. Two studies have demonstrated that ACE inhibitors have no effect on vascular function in patients with type 1 DM, even after 6 months on the drug (196,197). However, O'Driscoll and colleagues found improvement in endothelial function by ACE inhibition in...

HMG CoA Reductase Inhibitors

Large clinical trials have determined that hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) significantly reduce cardiovascular morbidity and mortality. Furthermore, lipid-lowering therapy has been shown to improve endothelial function in several studies (204,205). Attempts to ameliorate the impaired endothelium-dependent vascular relaxation that occurs in diabetic patients with dyslipidemia are few and the results mixed. Impaired endothelium-dependent vasodilation in patients with type 2 DM with dyslipidemia has been reported to improve with fibrate therapy (206) (which lowers the serum triglyceride level) but not with simvastatin (206,207). 66. Clarkson P, et al. Impaired vascular reactivity in insulin-dependent diabetes mellitus is related to disease duration and low density lipoprotein cholesterol levels. J Am Coll Cardiol 1996 28(3) 573-579. 77. Gilligan DM, et al. Selective loss of microvascular endothelial function in human hypercholesterolemia. Circulation 1994...

Abnormal Blood Cholesterol and Other Lipids

Cholesterol is necessary for a variety of bodily functions including the formation of plasma membranes and as a building block for hormones. Cholesterol is obtained through ingestion and synthesis in the body and is transported throughout the body by LDL and HDL. Elevation in plasma total cholesterol and LDL levels are clearly associated with increased risk of CVD, including CHD and stroke. High blood cholesterol levels are estimated to cause 4.4 million deaths annually that amount to over 18 of strokes and 56 of CHD.7 The current guidelines for plasma cholesterol and other lipids indicate that patients with total cholesterol of > 240 mg dL _ 1 are twice as likely to experience heart disease as a person whose total cholesterol is less than 200mgdL_ 1. Similarly, patients with LDL cholesterol levels of > 190mgdL_ 1 are considered as 'high risk' patients for CVD. In patients with diabetes or existing CHD, the LDL cholesterol level that places an individual at risk decreases to...

Adrenoceptor Antagonists

A-Adrenoceptors are subdivided into two major classes, ai and a2, each of which has three subclasses. Antagonists of a adrenoceptors, e.g., quinazolines (prazosin, doxazosin, and terazosin), are antihypertensive (Figure 2). They are selective for a1-adrenoceptors, but not for any of the three subclasses (a1A, a1B, and a1D) Unlike older a-adrenoceptor antagonists phenoxybenzamine and phentolamine, quinazolines do not increase heart rate. Prazosin was widely used in the treatment of hypertension for a quarter of a century. The onset of action of prazosin is rapid the maximal antihypertensive effect is usually reached within 2 h of oral administration of the drug. An important advantage of prazosin and other quinazolines over thiazides or -adrenoceptor antagonists is their favorable effect on blood lipids they tend to decrease triglycerides and low-density lipoprotein, while increasing high-density lipoprotein cholesterol levels. Terazosin inhibits ex vivo platelet aggregation induced by...

Importance of planned behavioral change

Pitfall 2 Development of an intervention intended to change a behavior for which there is no consensus about the relation to the problem. This can be illustrated by the discussion on cholesterol testing. Only recently has some consensus been reached about the relationship between cholesterol plasma levels and specific cardiovascular health problems. In addition, currently the relationship between diet and cholesterol levels is being questioned. As a result, interventions intended to lower the cholesterol content of diets may have limited effects on health. Changing behaviors which are not unequivocally related to a problem will not be helpful in reducing the problem.

Education as a method of dietary behavioral change

Programs aimed at students were found to impart knowledge, but not to lead to behavioral change. As far as high-risk groups such as patients with diabetes, cancer, kidney problems, high blood pressure, high cholesterol level, and obesity are concerned, maintenance of behavioral change (diet compliance) is the major problem. Mass media nutrition education programs do not yield positive results. Successful nutrition education programs are characterized by interpersonal contact, social support, self-control, and feedback. Adaptation of the intervention to the individual's attitudes and skills is effective. Interventions aimed at groups (e.g., patient groups) and those based on relapse prevention techniques are promising. For example, in the Netherlands, a large number of programs are available, but subsequent evaluation is often lacking. The Way of Life television campaign, intended to combine health education with entertainment, appeared to attract people's attention, and to heighten...

Discharge And Home Healthcare Guidelines

The nonsurgical patient is discharged to the home setting. The surgical patient is usually discharged to the home setting if a support system can be identified. An extended-care facility may be required for a short time if a support system is not in place for the patient at the time of discharge. Be sure the patient understands all medications prescribed, including dosage, route, action, and side effects. Provide patients and their families with information about a low-fat, low-cholesterol diet (reduced-calorie if obese). Be sure the patient understands the importance of controlling blood pressure and blood cholesterol levels in the prevention of progression of the atherosclerotic process.

Quantitativequalitative abnormalities of lipoproteins

VLDL levels has been attributed to increased hepatic production or decreased clearance of VLDL (111) and may be very significant in the development of arteriosclerosis in diabetes and in women (112). HDL levels in diabetes vary with the type of diabetes and, in some groups, with glycemic control. In type 2 diabetic patients, HDL levels are usually low and do not necessarily increase with improved metabolic control (107,110,113). The low HDL levels are secondary to an increased clearance rate by hepatic triglyceride lipase (114). In type 1 diabetic patients it has been shown that HDL cholesterol levels are low during poor glycemic control and increase to normal or above normal when adequate control is attained (108,110,115). Changes with improved glycemic control are less marked in women than in men (108). In type 1 black diabetic women, little association is observed between plasma lipid levels and glycemic control (115). HDL composition can also be markedly affected by diabetes, and...

Clinical manifestation

As knees, elbows, or buttocks may coalesce to form multilobated tumors associated with hypercholesterolemia and increased levels of LDL, with familial dysbetalipopro-teinemia and familial hypercholesterolemia or with secondary hyperlipidemias (e.g., nephrotic syndrome, hypothyroidism) Tendinous xanthoma variant slowly enlarging subcutaneous nodules around tendons or ligaments, often over extensor tendons of the hands, the feet, and the Achilles tendons sometimes occurs after trauma associated with severe hypercholesterolemia and elevated LDL levels, particularly in the type IIa form, or secondary hyperlipi-demias such as cholestasis Eruptive xanthoma variant sudden onset of crops of small, pruritic, red-yellow papules on an erythematous base, most commonly over buttocks, shoulders, and extensor surfaces of extremities may spontaneously resolve over weeks associated with hyper-triglyceridemia, particularly with types I, IV, and V (high concentrations of VLDL and chylomicrons) or with...

Wearable Devices and Wireless Networks

The surrogate markers they track determine which mode is most suitable a device that monitors the heart rate in a patient with a history of cardiac events must be constant, for example, whereas a device that monitors lipid levels in the bloodstream of a patient who has high cholesterol need only be intermittent.

Role Of Fatty Acid Oxidation In Other Diseases

Influence the development of these more chronic disease processes. They found that the BALB cByJ mice became significantly heavier and had significantly higher total serum cholesterol, HDL cholesterol, and triglyceride concentrations in the fed state than C57BL 6J mice. These authors did not mention the fact that these mice have SCAD deficiency. As more is learned by genetically manipulating lipid metabolism in mouse models, we can more fully understand the roles aberrant fatty acid metabolism plays in these complex, chronic disease processes.

Fields Of Expertise Within Toxicology

Cirrhosis of the liver is one of the most well-known adverse effects of chronic alcohol abuse. The cholesterol-lowering, life-prolonging statin drugs must be monitored routinely for hepatotoxicity and rhabdomyolosis. A Google search on the terms statins, hepatotoxicity, and review produced over 22,000 hits indicating this is a very active field of interest.

Bioprecursors and Bioreductive Agents

Bioprecursors activated by hydrolysis without loss of a promoiety imply a lactone ring opening. Here, the term 'hydration' appears preferable to 'hydrolysis,' given that the molecule is not split into two.4 Some among the successful statins (i.e., HMG-CoA reductase inhibitors) exemplify this case. Enzymatic hydration also occurs, in particular by serum paraoxonase. Thus, lovastatin was hydrolyzed at 37 C in undiluted plasma at rates that were highly species-dependent but seemingly always faster than nonenzymatic hydrolysis (about 0.4 per minute in human plasma, about 0.8 for dogs and monkeys, and about 10 and 50 rats and mice, respectively).99 In addition to oral absorption and enzymatic hydrolysis, hepatic extraction (passive or active) is also a major factor influencing the therapeutic activity of statins. This organ selectivity, together with the efficiency of enzymatic hydrolysis, does make some lactones useful prodrugs of HMG-CoA reductase inhibitors. However, additional factors...

Definition of Metabolic Syndrome

MetS is a commonly occurring cluster of clinical phenotypes that are individually and collectively strongly related to cardiovascular disease.2 MetS is characterized by disturbed carbohydrate and insulin metabolism, and is clinically defined by threshold values applied to indices of central obesity, dysglycemia, dyslipidemia, and or elevated blood pressure, which must be present concurrently in any one of a variety of combinations.2'3 The cardinal feature of MetS is abdominal obesity, as quantified most directly by increased waist circumference.4,5 Biochemically, MetS is characterized by insulin resistance - hyperinsulinemia - and by dyslipidemia - most typically raised triglycerides and or reduced HDL cholesterol. Additionally, a range of biochemical abnormalities have been secondarily associated, including increased serum concentrations of apolipoprotein B, fibrinogen, free fatty acids, C-reactive protein (CRP), tumor necrosis factor (TNF)-a, interleukin-6, and plasminogen activator...

Discovery of the Prototype Azetidinone Cholesterol Absorption Inhibitor

The discovery program that led to ezetimibe began as a traditional drug discovery program to discover novel acyl-coenzyme A cholesterol acyltransferase (ACAT) inhibitors.14 Although ACATwas known to be involved in a variety of cholesterol trafficking events including cholesterol absorption in rodents, the relevance of ACAT in nonrodent species was still unclear at the time this program began. Nonetheless, a variety of structural classes were known to be potent ACAT inhibitors in vitro and to be active in rodent animal models that reflect a potential for lowering cholesterol levels. Among these models was the cholesterol-fed hamster.15 A high-cholesterol diet dramatically increases liver cholesteryl ester (CE) levels in these animals, making them especially sensitive to ACAT inhibition. By contrast, serum cholesterol (SC) levels are not dramatically changed by cholesterol feeding in these animals, and most ACAT inhibitors have minimal effect on serum cholesterol levels. Figure 1 shows...

Nonsteroidal Antiestrogens

It is relevant to point out that the antiestrogen MER25 is a structural derivative of the cholesterol-lowering drug triparanol (MER29) (Figure 1). In the late 1950s there was initial enthusiasm about the potential benefits of triparanol as a hypocholesterolemic drug.14 However, the finding that triparanol caused an accumulation of desmosterol (an intermediate in cholesterol biosynthesis)15-18 and the linking of this biochemical effect to cataract formation,19-21 caused withdrawal of the drug in 1962 (Figure 2). Nevertheless, triparanol was first evaluated as a potential therapy for breast cancer22 but again the results were disappointing. Figure 2 The mechanism of action of triparanol is to inhibit cholesterol biosynthesis but also to increase demosterol levels which is implicated in cataract formation. In contrast, tamoxifen has an alternate mechanism of action to lower cholesterol levels.

Markers of Inflammation and Oxidant Stress in Coronary Heart Disease

Currently, there are no validated biomarkers of either inflammation or oxidant stress that can be used predictably for drug intervention in CHD patients. C-reactive protein (CRP), whose biological function is undetermined, has been proposed as a potential marker of inflammation, particularly in patients with acute coronary syndromes (ACS).6 Whether CRP is produced in response to inflammation or contributes directly to an inflammatory response is still unknown. However, elevated plasma CRP levels may represent an independent risk factor for CHD in the general population, even in subjects with near-normal cholesterol levels.1'6 Subjects with the lowest quintile of plasma cholesterol had a twofold higher risk of CHD when their plasma CRP levels fell in the highest CRP quintile. Similarly, subjects having plasma cholesterol levels in the highest quintile doubled their CHD risk as their CRP levels increased from the lowest to the highest quintile. Subjects with near-normal cholesterol...

The In Vivo Activity of SCH 48461

The effect of SCH 48461 in cholesterol-fed rhesus monkeys is summarized, along with control animals, in Figure 3. The total serum cholesterol level in the control animals steadily increased over a period of 3 weeks compared with the monkeys dosed with SCH 48461 at 1 mgkg_ 1 over the course of the same period. The serum cholesterol levels did not show any significant change in the SCH 48461 group, and remained at the baseline. At the end of 3 weeks the control animals were administered SCH 48461 at 1 mgkg_ and it was observed that their cholesterol levels returned back to the baseline in a short period of time. The withdrawal of SCH 48461 from the second group of monkeys resulted in the rise of their serum cholesterol levels, again in a very short period of time. These results unequivocally established that SCH 48461 is a potent inhibitor of cholesterol absorption in various species of animals, and, based on its lack of ACAT inhibitory activity, it was obvious that SCH 48461 inhibited...

Age Related Macular Degeneration

Although clinical trials for several different approaches to treat dry AMD could in theory be justified based on clinical observations and preclinical research (e.g., statins, apoptosis inhibitors, and anti-inflammatory drugs), there are only a few methods currently being investigated in clinical trials. One is the use of the carotenoid pigment, lutein (Figure 4) as an oral supplement. In theory the anti-oxidant and preferential retinal accumulation properties of lutein would be expected to have a salutary effect on dry AMD progression, but the unexpected negative effect of b-carotene consumption on lung cancer development in smokers counsels caution.

Mainstream drugs from edible plants

Certain active pharmaceutical ingredients occur naturally in food plants and spices. With a few notable exceptions (statins, xanthines, capsaicinoids), the concentrations are very low and unlikely to exert any direct significant pharmacological activity. This background dietary 'pharmaceutical noise' can, however, become significant under particular conditions, especially in the realm of exposure to recreational drugs like tobacco and opioids.


Measure total cholesterol and high-density lipoprotein (HDL) every 5 years (unless abnormal), starting at age 20 (although this recommendation is not universally accepted). Start, earlier if the patient is obese or has a strong family history. Look for xanthelasma (know what it looks like), corneal arcus (in younger patients), lipemic-looking serum, and obesity as markers of possible familial, hypercholesterolemia. Family members should be tested. Also, look for pancreatitis with no risk factors (e.g., no alcohol, gallstones) as a marker for familial hypertriglyceridemia. Risk factors for coronary heart disease (LDL and total cholesterol are risk factors for CHD, but do not count them in deciding to treat or not to treat high cholesterol) a Hypertriglyceridemia alone is not considered a risk factor, but when associated with high cholesterol causes more coronary heart disease than high cholesterol alone, First-line agents are niacin (poorly tolerated but effective) and bile...


The purpose of clinical trials is not only to investigate or verify some scientific or medical hypotheses of certain interventions in a group of patients but also to be able to apply the results to the targeted patient population with similar characteristics. This process is called (statistical) inference. It is the process by which clinicians can draw conclusions based on the results observed from the targeted patient population. Suppose that a clinical trial is planned to study the effectiveness of a newly developed cholesterol-lowering agent in patients with hypercholesterolemia as defined by nonfasting plasma total cholesterol level being greater than 250mg dL. Furthermore, assume that this new agent is extremely promising as shown by previous small studies and that the elevation of the cholesterol level is a critical factor for reduction of the incidence of coronary heart disease. For this reason, the government is willing to provide unlimited resources so that every patient with...

Oats Avena sativa

Oats are descended from A. sterilis, a wild oat that spread as a weed of wheat and barley from the Fertile Crescent to Europe. In the wetter, colder conditions of Europe, in which oats thrive, it was domesticated about 3000 years ago, and soon became an important cereal in its own right on the cooler fringes of Europe. In medieval Britain oats were widely grown for bread, biscuits, and malting, but they now hold their importance only in the wetter parts of northern Europe. Oats are still an important food in Scotland, where uses include porridge, oatcakes, and the filling for haggis. Oats have also had an important role since the Roman period as feed for horses. British emigrants introduced oat cultivation to North America in the 17th century, but they have always been a minor cereal outside Europe. Oat bran is rich in a type of dietary fiber that has been shown to reduce cholesterol levels, and this has led to increased interest in its consumption.

Animal Studies

It is generally accepted that dietary cholesterol, saturated fats, and animal protein increase the concentration of total cholesterol in blood and raise the risk the hypercholesterolemic and atherogenic action of dietary cholesterol, saturated fats, and animal proteins (12). Similar to the effects on blood cholesterol levels, separate components of dietary fiber differently influence liver cholesterol levels in laboratory animals. Supplementation of a rat diet with insoluble fibers such as cellulose raised liver cholesterol above that of the control group of rats. Contrary to this, in rats receiv-


In more than half of all diabetic patients, especially those with type 2 diabetes and insulin resistance, decreases in high-density lipoprotein (HDL) cholesterol and hypertriglycemia have been reported (102). Increases in low-density lipoprotein (LDL) cholesterol levels are also frequently observed in diabetic patients, but such increases are more frequently in those with poor glycemic control or in parallel with hypertriglycemia. Additionally, LDLs can be modified in diabetes, as in the formation of glycated or oxidized LDLs (103,104), which have a decreased metabolism or are atherogenic. HDLs, which are decreased in diabetic states, reduce the inhibitory effect of LDL on endothelium-mediated vasodilation (108). Hypercholesterolemia increases the expression of endothelial adhesion molecules and platelets aggregability and adhesion (109112), and augmenting vasoconstriction. Small, dense LDLs, which are known to be a potent risk factor for coronary heart disease, oxidize easily and are...

Preface And Overview

The current opportunities to educate consumers utilizing clearly defined food labels have never been greater. Using the synergy between the Nutrition Labeling and Education Act (NLEA) and the revised Food Guide Pyramid has facilitated great strides toward a better understanding on the part of the public regarding the constituents of a healthy diet. Just as it has learned the terms saturated fat, soluble fiber, and dietary cholesterol, the public is capable of understanding the term complex carbohydrate if the scientific issues are clarified. The primary questions are

Types of Studies

A hypothesis, in its most basic form, is a statement that postulates a difference exists between two or more groups. For example, a new cholesterol-lowering drug X is compared to an old drug Y. The hypothesis for this comparison could state (blandly), treatment cohort A has a lower total serum cholesterol than cohort B, because treatment cohort A was treated with drug X, while cohort B was treated with drug Y. This draws a distinction between cohorts A and B. Once a hypothesis is created, it must be tested and withstand scrutiny. Studies are conducted, but the hypothesis must still be statistically proven to be true to be accepted. To do this, statistics employs a special tool to test the validity (effectively the sensitivity and specificity) of a hypothesis. This tool is simply the opposite of the hypothesis. If the hypothesis claims a difference between two groups, the null hypothesis claims that no significant difference exists between the groups. Statistical analysis proceeds to...

Clinical Results

Human clinical trials with ezetimibe supported the expectations of animal studies with ezetimibe both as monotherapy and in combination with statins.40-43 Table 1 shows the results of phase III human trials with ezetimibe as monotherapy. Ezetimibe produced a significant reduction in total cholesterol, LDL cholesterol, and triglycerides as well as a small but significant increase in HDL cholesterol. LDL cholesterol Total cholesterol HDL cholesterol Triglycerides achieved by the statin alone. Finally, Figure 25 compares the effect of a high dose of statin alone with a low dose of statin coadministered with ezetimibe. In each case, coadministration of ezetimibe and low-dose statin produced an equivalent reduction in LDL cholesterol as the high dose of statin alone. Combined, these data demonstrate that ezetimibe alone or coadministration with statins provides favorable effects on the major lipid parameters in patients with hypercholesterolemia.


Basically blinding in clinical trials can be classified into four types open label, single blind, double blind, and triple blind. An open-label study is a clinical trial in which no blinding is employed. That is, both the investigator and the patient have an idea about which treatment the patient receives. Since patients may psychologically react in favor of the treatments they receive if they are aware of which treatments they receive, a serious bias will occur. For example, for the development of topical cream for the indication of some skin disorder, after revelation of the dose, two investigators were asked to give their global evaluation of a patient based on a four-point scale. Despite the fact that the procedures for global evaluation are clearly stated in the protocol, the two investigators gave a rather different evaluation for the patient simply because one of them did not believe that the drug really works at the dose for the patient received and the other one is an...


Bazedoxifene (TSE-424 Figure 10) is a novel SERM developed by Wyeth Pharmaceuticals that is currently in phase III clinical trials for the prevention and treatment of postmenopausal osteoporosis. It is an indole-based estrogen receptor ligand that has been stringently selected to ensure an improved profile over its predecessor raloxifene. It was developed using preclinical selection parameters, which included favorable effects on the skeleton and lipid metabolism, demonstrable mammary and uterine safety, and neutral effects on hot flashes.192 Bazedoxifene treatment maintains bone mineral density, preserves normal bone histology, increases bone compressive strength, and reduces total cholesterol levels in animal models.192-194 It lacks uterotropic activity194 and it blocks raloxifene-induced increases in uterine weight192 and inhibits E2-induced proliferation in MCF-7 breast cancer cells.192 Based on the favorable preclinical evaluation, it is suggested that bazedoxifene has the...

The Future

Exploiting existing drugs, which have already passed safety hurdles for other indications, is an approach that also promises faster results than a conventional drug development path. Statins for autoimmune disease are just one such example. Even if they prove to be nonoptimal therapies on their own, these 'repurposed' therapies can point toward key alternative pathways, or may prove to be effective when used in synergy with other approaches. This approach is a reflection of a welcome trend to take - rather than an organ-specific approach, a more cross-disciplinary approach to exploit the commonalities of the various autoimmune diseases.

Amphotericin B

Imidazoles Miconazole, clotrimazole. Toxicity Increased drug-drug interactions Drug-drug interactions Azoles inhibit CYP3A4, responsible for metabolizing many drugs, including statins, H1-blockers, steroids, benzodiazepines, calcium channel blockers (CCBs).

Soluble Fiber

Soluble fiber comprises about 25 of the dietary fiber consumed but strong evidence shows that soluble fiber as part of a low-fat, low-cholesterol diet may help lower blood cholesterol in those individuals with elevated blood cholesterol levels. It has also been shown to help control blood glucose levels in individuals with diabetes mellitus. Good sources of soluble fiber are whole-grain oats and barley, oat bran, some fruits, dried beans, and other legumes. According to current nutrition labeling regulations dietary fiber-containing food must have at least 2.5 grams fiber per reference serving to make a ''good'' source claims and at least 5.0 grams of fiber to make an ''excellent'' source claim.


Q QH2 is the only lipid soluble antioxidant that can be synthesized by mammalian cells the other lipid soluble antioxidants (vitamin E, -carotene) must be derived from the diet. The studies reviewed in this chapter employed a combination of genetics and biochemistry to delineate the biosynthetic steps responsible for production of Q. Just as an understanding of cholesterol synthesis and metabolism provided important insights for control of LDL cholesterol levels in patients with hypercholesterolemia,38 it seems likely that characterization of the biosynthesis of Q will benefit our understanding of Q metabolism, its possible role in aging, and the use of Q in clinical therapies.

Rice Bran

The unsaponifiable fraction consists of compounds such as oryzanols, beta-sitosterol, and tocopherols, which may have cholesterol-lowering activity. The major carbohydrates in commercial rice bran are cellulose, hemicellulose, and starch. Starch is not present in the outer pericarp layers, but because of endosperm breakage during milling it appears in the bran. The quantity varies according to the amount of breakage and degree of milling, but values of 10-20 percent are typical. Hemicellulose and cellulose have been reported to comprise 8.7-11.4 percent and 9.6-12.8 percent of the bran. Beta-glucans in the bran are present at levels of less than 1 percent.

Lower Your Cholesterol In Just 33 Days

Lower Your Cholesterol In Just 33 Days

Discover secrets, myths, truths, lies and strategies for dealing effectively with cholesterol, now and forever! Uncover techniques, remedies and alternative for lowering your cholesterol quickly and significantly in just ONE MONTH! Find insights into the screenings, meanings and numbers involved in lowering cholesterol and the implications, consideration it has for your lifestyle and future!

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